IntroductionAcute appendicitis is the most common surgical emergency globally, with an incidence of 1.17 per 1000. The lifetime risk of acute appendicitis is 8.6% in men and 6.7% in women and its incidence is highest in adolescents and young adults.(1)  Although appendicitis is a common condition, it remains a diagnostic challenge for surgeons, mainly in pregnant women. Clinical diagnosis alone leads to a negative appendectomy rate of 15 to 30%.(2, 3) Different scoring systems have been developed for diagnosing acute appendicitis and the most commonly used is Alvarado score.(4) We hereby present an unusual case of mega appendix.